Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
Am J Prev Med. 2010 Nov;39(5):411-20. doi: 10.1016/j.amepre.2010.07.004.
No high-quality study to date has shown that screening reduces lung cancer mortality, and expert groups do not recommend screening for asymptomatic individuals. Nevertheless, lung cancer screening tests are available in the U.S., and primary care physicians (PCPs) may have a role in recommending them to patients.
This study describes U.S. PCPs' beliefs about and recommendations for lung cancer screening and examines characteristics of PCPs who recommend screening.
A nationally representative survey of practicing PCPs was conducted in 2006-2007. Mailed questionnaires were used to assess PCPs' beliefs about lung cancer screening guidelines and the effectiveness of screening tests and to determine whether PCPs would recommend screening for asymptomatic patients. Data were analyzed in 2009.
Nine hundred sixty-two PCPs completed the survey (absolute response rate=70.6%; cooperation rate=76.8%). One quarter said that major guidelines support lung cancer screening. Two thirds said that low-radiation dose spiral computed tomography (LDCT) screening is very or somewhat effective in reducing lung cancer mortality in current smokers; LDCT was perceived as more effective than chest x-ray or sputum cytology. Responding to vignettes describing asymptomatic patients of varying smoking exposure, 67% of PCPs recommended lung cancer screening for at least one of the vignettes. Most PCPs recommending screening said they would use chest x-ray; up to 26% would use LDCT. In adjusted analyses, PCPs' beliefs and practice style were strongly associated with their lung cancer screening recommendations.
Many PCPs' lung cancer screening beliefs and recommendations are inconsistent with current evidence and guidelines. Provider education regarding the evidence base and guideline content of lung cancer screening is indicated.
迄今为止，尚无高质量研究表明筛查可降低肺癌死亡率，专家组也不建议对无症状个体进行筛查。然而，美国提供肺癌筛查检测，初级保健医生（PCP）可能在向患者推荐这些检测方面发挥作用。
本研究描述了美国 PCP 对肺癌筛查的看法和建议，并探讨了推荐筛查的 PCP 的特征。
2006-2007 年对执业 PCP 进行了一项全国代表性调查。采用邮寄问卷评估 PCP 对肺癌筛查指南和筛查检测有效性的看法，并确定 PCP 是否会建议无症状患者进行筛查。数据于 2009 年进行分析。
962 名 PCP 完成了调查（绝对响应率=70.6%；合作率=76.8%）。四分之一的人表示主要指南支持肺癌筛查。三分之二的人表示低剂量螺旋 CT（LDCT）筛查对降低当前吸烟者的肺癌死亡率非常有效或有些效果；LDCT 被认为比胸部 X 线或痰液细胞学检查更有效。针对描述不同吸烟量的无症状患者的病例，67%的 PCP 至少对一个病例建议进行肺癌筛查。大多数建议筛查的 PCP 表示他们会使用胸部 X 线；高达 26%的人会使用 LDCT。在调整后的分析中，PCP 的信念和实践风格与他们的肺癌筛查建议密切相关。
许多 PCP 的肺癌筛查信念和建议与当前证据和指南不一致。需要对提供者进行有关肺癌筛查证据基础和指南内容的教育。
